Jaishree Mohanbabu, Abishek Manogaran, Sri Harish Kumar Srinivasan, Anandan Prabakar Rohith, Kuppusamy Anand, Muhasaparur Ganesan Rajanandh
Oral NAC did not significantly affect early postoperative cognitive or physiological recovery in elderly day-surgery patients but was associated with improved quality of recovery.
INTRODUCTION: Postoperative cognitive dysfunction (POCD) refers to a decline in cognitive ability following surgery. N-acetylcysteine (NAC) has antioxidant and neuroprotective properties; however, clinical evidence supporting its role in reducing POCD in elderly patients undergoing day surgery remains limited. This study evaluated the effect of oral NAC on POCD recovery among older adults undergoing day surgery.
METHODS: This randomized controlled trial included elderly patients undergoing outpatient surgery with American Society of Anaesthesiologists physical status I-III. Participants received oral NAC (400-600 mg) or placebo. NAC was administered preoperatively and twice daily for two postoperative days. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA) at baseline (2 hours before surgery) and 24 hours postoperatively. Physiological recovery and readiness for discharge were assessed using the Modified Aldrete Score (MAS), while quality of recovery was evaluated using the Quality of Recovery-40 (QoR-40) questionnaire.
RESULTS: Of 417 randomized patients, 296 were included in the final analysis (148 in each group). Within-group analysis showed no significant change in MoCA scores from baseline to 24 hours postoperatively in either the test group (p = 0.959) or the control group (p = 0.734). No significant between- group difference was observed in MAS (p > 0.05). In contrast, QoR-40 was significantly higher in the Test group compared with the control group (p < 0.05). No drug-related adverse events were observed during the study period.
DISCUSSION: NAC improved quality of recovery but not postoperative cognitive function MoCA. Discharge readiness, MAS is unaffected. Hence, larger and longer follow-up investigations are needed.
CONCLUSION: Oral NAC did not significantly affect early postoperative cognitive or physiological recovery in elderly day-surgery patients but was associated with improved quality of recovery.